Being a mother is hard work, but when you add a mental illness, motherhood can seem like an impossible task. Some people still believe that a woman with a mental illness will not be able to cope with motherhood and should give up her children. I believe that with education and support, many women with mental illness are able to continue in the important role of mother.

I became ill as a teenager, but for several years mismanaged the symptoms of my bipolar disorder with alcohol. Much of my illness was depression, and I felt hopeless and out of control most of the time. Alcohol seemed to provide a temporary respite from my mood. In retrospect, alcohol probably worsened my depression, but at the time I was looking for anything that would provide temporary relief.

I had married at age 19. At age 21 I decided that children would change my life and make me happier, so at age 22 my first daughter was born. Then in 13 months my second daughter was born. Two years later I had my third daughter, and in another year my fourth and last daughter.

My daughters were born happy and healthy, but what I had hoped for—namely, an improved mood and purpose in life—was not fulfilled. In fact, quite the opposite occurred. With each pregnancy I became a little more despondent. Postpartum depressions exacerbated my bipolar disorder, and by the end of my third pregnancy I was almost nonfunctional. Whereas in the past my mental illness had been denied by my family, now it was so apparent that it could not be ignored. During my fourth pregnancy, I went into treatment for the first time. At that point, I felt empty inside, and because of that emptiness, I felt like a bad wife and mother.

The focus of my early treatment was on examining what was going wrong in my life and eliminating it. My children were viewed as major stresses. Instead of getting recommendations for parenting classes and family treatment, I was urged to simplify my life. I was encouraged to believe that I couldn't cope with my children. Although this idea left me feeling guilty and inadequate, the people caring for me seemed to believe it, so I thought it must be true.

After my fourth daughter was born, I became so ill that I made my first suicide attempt and had my first psychiatric hospitalization. I felt very depressed and hopeless. The added burden of caring for a new baby along with my three other children seemed overwhelming. I didn't think I could cope, and death seemed to be the only way out. I survived that suicide attempt, but things went downhill very quickly from there.

My husband, who had been viewed as yet another stress in my life, decided to divorce me and was able to get temporary custody of our four small daughters. My life was in total chaos, and I didn't know where to turn for support. I felt alone and helpless. In retrospect, I needed someone who could have advocated for me to keep my family together.

None of the mental health professionals involved in my treatment at that point attempted to intervene with my young family. There was no education for my husband about my bipolar disorder, what the course of my illness would be, or how he could help me manage it. No effort was made to keep my family together. It seemed that someone had made a judgment that I would be better off without the stresses of my husband and children, so the demise of my family was permitted to occur with no attempt to prevent it.

I wanted to keep my family together and was devastated by the loss, but people saw my despair as part of my illness. No one, professionals or family members, thought it was possible for me to maintain my family while coping with bipolar disorder. The message was that I was a hopeless case.

The next four years were very traumatic for me. I had multiple hospitalizations, and I was divorced from my husband. I saw my daughters, but only a day or two a week. I was no longer a primary caretaker for them, and my role as mother was dramatically changed. I experienced a tremendous sense of loss about my daughters, but I believed that I couldn't cope with caring for them.

No one made an effort to support me in caring for my children. Either I had the children and was totally responsible for their care, or I didn't have them. There was no in-between, and no effort to develop an alternative plan that would help me negotiate the demands of my mental illness and motherhood.

I feel that I was pressured by my treatment providers to give up the care of my children. I think this course was the easy way out for them. Rather than having to help me find ways to cope with my daughters, they chose to deal only with me. I felt defeated as a mother, and due to my lack of self-confidence and the total absence of support from either professionals or family, I reluctantly accepted defeat.

Over the past 16 years, as I have gained more stability in my mental illness, I have educated myself and my daughters about my disorder. I have worked very hard to develop relationships with them. I see them every few weeks and talk to them two to three times a week on the telephone. For years I felt guilty for not fulfilling my role as mother, but I have come to realize that under the circumstances, without support, I did the best I could. Still, my daughters and I feel the loss of a closer relationship.

I think that if treatment providers had viewed my role as a mother as one of primary importance, my life might have turned out differently. Early on, there should have been education about mental illness for me and my family. Keeping the family unit intact should have been a primary goal. If my marriage couldn't handle the strain, a major effort still could have been made to help me care for my children. Instead of being convinced I couldn't cope, I needed support and encouragement to care for them. I needed someone to believe I could do it. Regular day care for the children and someone coming into my home to help when the girls were small were possibilities that were not even considered.

Motherhood is a wonderful, fulfilling experience, one that women with a mental illness have every right to experience and enjoy. Treatment providers need to believe that women with a mental illness can be good mothers, and they should focus their efforts on designing plans to help women achieve this role. There is a need for more family-based treatment in which clinicians go into the home and evaluate and work with mentally ill mothers and their families. Professionals need to observe the mothers interacting with their children to determine what kind of education and support the mothers need to keep their children and successfully manage their mental illness.

Couples also need help negotiating child care responsibilities. Ongoing family treatment should be part of every treatment plan for mothers with a mental illness, with an emphasis on developing parenting skills, communication skills, problem-solving skills, and ability to manage stress.

In my recovery, I have regained many things that I lost. I have loving relationships with my daughters, I have a new husband and family, and I am able to work in the field of mental health and help people who have suffered some of the same losses I did. Professionals need to be aware that parenting and mental illness are not mutually exclusive. We must listen to what people want and need and must support them in working toward their goals.

Ms. Fox is a research associate at the New Hampshire-Dartmouth Psychiatric Research Center, State Office Park South, 105 Pleasant Street, Concord, New Hampshire 03301. Jeffrey L. Geller, M.D., M.P.H., is editor of this column.